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Bad news

Abby R Rosenberg, Joanne Wolfe, Lori Wiener, Maureen Lyon, Chris Feudtner
Importance: For clinicians caring for adolescent patients living with progressive, life-threatening illness, discussions regarding prognosis, goals of care, and treatment options can be extremely challenging. While clinicians should respect and help to facilitate adolescents' emerging autonomy, they often must also work with parents' wishes to protect patients from the emotional distress of hearing bad news. Observations: We reviewed the ethical justifications for and against truth-telling, and we considered the published ethical and practice guidance, as well as the perspectives of patients, parents, and clinicians involved in these cases...
October 17, 2016: JAMA Pediatrics
Umberto Maggiore, Julio Pascual
Cancer immunotherapy, especially the use of checkpoint inhibitors, is expanding and can be efficacious in organ transplant recipients with malignant neoplasia. In this review, we summarize clinical findings and evolution of several patients treated with CTL4-4 or PD-1 inhibitors reported in the literature. The CTL-4 inhibitor ipilimumab has been safely used in several liver and kidney allograft recipients. PD1-inhibitors look promising for tumor shrinking, but acute rejection is the rule, so they should be avoided in recipients of life-saving organs...
September 2016: Advances in Chronic Kidney Disease
Åsa Rejnö, Gunilla Silfverberg, Britt-Marie Ternestedt
BACKGROUND: Ethical problems are a universal phenomenon but rarely researched concerning patients dying from acute stroke. These patients often have a reduced consciousness from stroke onset and thereby lack ability to convey their needs and could be described as 'incompetent' decision makers regarding their own care. OBJECTIVE: The aim of the study was to deepen the understanding of stroke team members' reasoning about truth-telling in end-of-life care due to acute stroke...
September 22, 2016: Nursing Ethics
Megan Winner, Ana Wilson, Sean Ronnekleiv-Kelly, Thomas J Smith, Timothy M Pawlik
BACKGROUND: Patients with cancer often have an overly optimistic view of prognosis, as well as potential benefits of treatment. Patient-surgeon communication in the preoperative period has not received as much attention as communicating prognosis or bad news in the postoperative setting. METHODS: The published literature on patient-physician communication in the preoperative setting among patients considering surgery for a malignant indication was reviewed. PubMed was queried for MESH terms including "surgery," "preoperative," "discussion," "treatment goals," "patient perceptions," and "cure...
September 8, 2016: Annals of Surgical Oncology
Donald J Hagler
Current delivery systems for the Sapien XT valve for the native pulmonary valve are unacceptable stiff and poorly design for implantation in the pulmonary outflow tract. This report details improvisation of the Melody Ensemble for easier pulmonary outflow tract delivery of the Sapien XT valve. The unacceptable cost of the utilization of two delivery systems for valve implantation, requires industry development of an safe, effective delivery system appropriate for the pulmonary outflow tract.
September 2016: Catheterization and Cardiovascular Interventions
Jennifer M Snaman, Erica C Kaye, Melody J Cunningham, April Sykes, Deena R Levine, Daniel Mahoney, Justin N Baker
BACKGROUND: Medical trainees consistently report suboptimal instruction and poor self-confidence in communication skills. Despite this deficit, few established training programs provide comprehensive, pediatric-specific communication education, particularly in the provision of "bad news." To our knowledge, no programs currently use bereaved parent educators to facilitate communication training for pediatric subspecialty trainees. PROCEDURE: The authors designed and implemented a pilot communication training seminar in which bereaved parent educators and faculty facilitators led small groups in interactive, role-play scenarios...
September 8, 2016: Pediatric Blood & Cancer
Inês Fortes, Marco Vasconcelos, Armando Machado
Several studies have shown that, when offered a choice between an option followed by stimuli indicating whether or not reward is forthcoming and an option followed by noninformative stimuli, animals strongly prefer the former even when the latter is more profitable. Though this paradoxical preference appears to question the principles of optimal foraging theory, Vasconcelos, Monteiro, and Kacelnik (2015) proposed an optimality model that shows how such preference maximizes gains under certain conditions. In this paper, we tested the model's core assumption that a stimulus signaling the absence of food should not influence choice independently of its other properties, such as probability or duration...
October 2016: Journal of Experimental Psychology. Animal Learning and Cognition
Richard B L Lim
Despite advances in the detection, pathological diagnosis and therapeutics of lung cancer, many patients still develop advanced, incurable and progressively fatal disease. As physicians, the duties to cure sometimes, relieve often and comfort always should be a constant reminder to us of the needs that must be met when caring for a patient with lung cancer. Four key areas of end-of-life care in advanced lung cancer begin with first recognizing 'when a patient is approaching the end of life'. The clinician should be able to recognize when the focus of care needs to shift from an aggressive life-sustaining approach to an approach that helps prepare and support a patient and family members through a period of progressive, inevitable decline...
October 2016: Therapeutic Advances in Respiratory Disease
Marie Allen, Mia Bjerke, Hanna Edlund, Sven Nelander, Bengt Westermark
Human tumor-derived cell lines are indispensable tools for basic and translational oncology. They have an infinite life span and are easy to handle and scalable, and results can be obtained with high reproducibility. However, a tumor-derived cell line may not be authentic to the tumor of origin. Two major questions emerge: Have the identity of the donor and the actual tumor origin of the cell line been accurately determined? To what extent does the cell line reflect the phenotype of the tumor type of origin? The importance of these questions is greatest in translational research...
August 31, 2016: Science Translational Medicine
Bryan A Sisk, Myra Bluebond-Langner, Lori Wiener, Jennifer Mack, Joanne Wolfe
Prognostic disclosure to children has perpetually challenged clinicians and parents. In this article, we review the historical literature on prognostic disclosure to children in the United States using cancer as an illness model. Before 1948, there was virtually no literature focused on prognostic disclosure to children. As articles began to be published in the 1950s and 1960s, many clinicians and researchers initially recommended a "protective" approach to disclosure, where children were shielded from the harms of bad news...
September 2016: Pediatrics
Michael H Roh, Andrew G Shuman
Cytopathology is a subspecialty of pathology in which pathologists frequently interact directly with patients. Often this interaction is in the context of fine needle aspiration (FNA) procedures performed at the bedside by the cytopathologist or by another clinician with the cytopathologist present. Patient requests for preliminary results in such settings raise fundamental questions about professional scope of practice and communication of uncertainty that apply not merely to pathologists but to all clinicians...
2016: AMA Journal of Ethics
Jonathan Mayes, Simon Davies, Andrew Harris, Emma Wray, Graham G Dark
Statistics show that more than one in two people born after 1960 in the UK will develop cancer during their lifetime. However, a 2013 study found that only 36 % of UK medical schools offer dedicated clinical teaching in oncology. The aim of this study was to assess the views of medical students on five domains of oncology before and after their first clinical placement, to assess the impact, and to obtain students' views on the oncology curriculum. A 28-item questionnaire was developed to compare responses before and after the students' first 2-week clinical placement, and impact was measured as a positive or negative deviation from a baseline response...
August 22, 2016: Journal of Cancer Education: the Official Journal of the American Association for Cancer Education
Traci LeMasters, S Suresh Madhavan, Usha Sambamoorthi
BACKGROUND: Breast conserving surgery (BCS) followed by radiation therapy (RT) (BCS+RT) is as effective for long-term survival of invasive early-stage breast cancer (ESBC) as mastectomy, and is the local treatment option selected by the majority of women with ESBC. Women of older age and vulnerable socio-demographic characteristics are at greater risk for receiving substandard (BCS only) and non-preferred treatments (mastectomy), such as populations of women from the Appalachian region of United States...
2016: Global J Breast Cancer Res
Marzieh Hasanpour, Narges Sadeghi, Mohammad Heidarzadeh
BACKGROUND AND AIMS: Newborn death is an unexpected outcome for parents. Parents face with several needs in infant end-of-life. The health care team is responsible for meet these needs. This qualitative study aim was to explore of parental needs in infant end-of-life and bereavement. MATERIALS AND METHODS: For this qualitative study, 24 single semi-structure interviews were done. A qualitative content analysis method was used. Sampling conducted on purposeful with maximum variation in five Neonatal Intensive Care Unit (NICU) environments in Isfahan city...
2016: Journal of Education and Health Promotion
Thomas W Bishop, James Gorniewicz, Michael Floyd, Fred Tudiver, Amy Odom, Kathy Zoppi
This workshop demonstrated the utility of a patient-centered web-based/digital Breaking Bad News communication training module designed to educate learners of various levels and disciplines. This training module is designed for independent, self-directed learning as well as group instruction. These interactive educational interventions are based upon video-recorded patient stories. Curriculum development was the result of an interdisciplinary, collaborative effort involving faculty from the East Tennessee State University (ETSU) Graduate Storytelling Program and the departments of Family and Internal Medicine at the James H...
May 2016: International Journal of Psychiatry in Medicine
Mohammad Mahdi Eftekharian, Masoud Sabouri Ghannad, Mohammad Taheri, Ghodratollah Roshanaei, Mehrdokht Mazdeh, Mehrnoosh Musavi, Mona Bahmani Hormoz
OBJECTIVES: Multiple sclerosis (MS) is a complicated disease which occurs due to relationship between genes and environmental factors that causes tissue damage by autoimmune mechanisms.We investigated and illustrated the hypotheses correlated to the evidence of several putative environmental risk factors for MS onset and progression in this part of Iran. MATERIALS AND METHODS: Univariate logistic regression was used to detect the effects of environmental factors on the risk of MS...
June 8, 2016: Human Antibodies
Alex Elliott-Green, Lirije Hyseni, Ffion Lloyd-Williams, Helen Bromley, Simon Capewell
OBJECTIVES: To assess the extent of media-based public health advocacy versus pro-industry messaging regarding sugar-sweetened beverages (SSBs). DESIGN: We conducted a systematic analysis to identify and examine all articles regarding SSBs published in all mainstream British print newspapers and their online news websites from 1 January 2014 to 31 December 2014. We initially conducted a brief literature search to develop appropriate search terms and categorisations for grouping and analysing the articles...
2016: BMJ Open
Samar M Aoun, Lauren J Breen, Robert Edis, Robert D Henderson, David Oliver, Rodney Harris, Denise Howting, Margaret O'Connor, Carol Birks
Communication of the diagnosis of MND is daunting for patients and neurologists. This study aimed to establish a knowledge base of current Australian practice of breaking the news of an MND diagnosis, to assess the neurologists' educational and training needs and to compare the feedback obtained from neurologists and patients to international practice guidelines. An anonymous survey of neurologists was undertaken in Australia (2014). 73 neurologists responded to this national survey (50.4% response rate). Nearly 70% of neurologists reported finding it "somewhat to very difficult" communicating the MND diagnosis, and 65% reported feeling moderate to high stress and anxiety at the delivery of diagnosis...
August 15, 2016: Journal of the Neurological Sciences
Francesca Alby, Cristina Zucchermaglio, Marilena Fatigante
In cancer communication, most of the literature is in the realm of delivering bad news while much less attention has been given to the communication of uncertain news around the diagnosis and the possible outcomes of the illness. Drawing on video-recorded cancer consultations collected in two Italian hospitals, this article analyzes three communication practices used by oncologists to interactionally manage the uncertainty during the visit: alternating between uncertain bad news and certain good news, anticipating scenarios, and guessing test results...
July 14, 2016: Journal of Cancer Education: the Official Journal of the American Association for Cancer Education
Martina Gamp, Britta Renner
BACKGROUND: Personalised health-risk assessment is one of the most common components of health promotion programs. Previous research on responses to health risk feedback has commonly focused on the reception of bad news (high-risk feedback). The reception of low-risk feedback has been comparably neglected since it is assumed that good news is reassuring and readily received. However, field studies suggest mixed responses to low-risk health feedback. Accordingly, we examine whether pre-feedback risk expectancies can mitigate the reassuring effects of good news...
July 14, 2016: Applied Psychology. Health and Well-being
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